SEARCH · PubMed Health

Results for “benchmark dose analysis”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources

PubMed2005

An occupational hygiene investigation of exposure to acrylamide and the role for urinary S-carboxyethyl-cysteine (CEC) as a biological marker.

Acrylamide has a range of toxicological hazards including neurotoxicity and reproductive toxicity; however, occupational risk management is driven by its genotoxic and carcinogenic potential (it is classified within the EU as a Category 2 carcinogen, R45 and Category 2 mutagen, R46). Since there is the potential for skin absorption and systemic toxicity, biological monitoring may be a useful aid for the assessment of exposure via inhalation, ingestion and dermal absorption. However, there are currently no biological monitoring guidance values (BMGVs). This study describes an extensive survey of potential workplace exposure to acrylamide at the Ciba (Bradford) site to gather data suitable for a BMGV. This manufacturing site is typical within the industry as a whole and includes a cross section of activities and tasks representative of acrylamide exposure. Acrylamide is used in the manufacture of polyacrylamide based products for applications in water treatment; oil and mineral extraction; paper, paint and textile processes. Workers (62 plus 6 controls) with varying potential exposures provided a total of 275 pre shift and 247 post-shift urine samples along with 260 personal air samples. A small non-exposed control group was similarly monitored. Urine samples were analysed for S-carboxyethyl-cysteine (CEC). Airborne, surface and glove samples were analysed for acrylamide. Inhalation exposures were well controlled with values consistently below one-tenth of the UK Workplace Exposure Limit. Engineering controls, personal protective equipment and work practice, all contributed to good control of occupational exposure. CEC was found in urine samples from both exposed workers and non-occupationally exposed controls. At the low levels of exposure found, smoking made a significant contribution to urinary CEC levels. Nevertheless a correlation between urinary CEC and airborne acrylamide was found. A mixed effects model incorporating inhalation concentrations of acrylamide and smoking habits could predict some of the variation in observed post-shift urine results but could be improved through the use of additional surface contamination data. However, the data does not suggest that dermal absorption was a major contributor to the systemic dose. Based on the 90th percentile of the data, inclusive of the effects of smoking and environmental factors, a value of 4 mmol mol(-1) creatinine is proposed as a pragmatic BMGV associated with good occupational hygiene practice and control of workplace exposure. CEC in urine analysis has the utility for routine use as a means to estimate biological uptake where there is a potential for significant exposure or loss of workplace control.

Acrylamide↗

PubMed2006

Stenotrophomonas maltophilia and antibiotic use in German intensive care units: data from Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in German Intensive Care Units).

Risk factors for the selection of Stenotrophomonas maltophilia were analysed by correlating antimicrobial use and structure parameters (e.g. hospital type) with the incidence density of S. maltophilia and the percentage of S. maltophilia isolated from 39 intensive care units (ICUs). SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in German Intensive Care Units) is a prospective unit- and laboratory-based surveillance system that collects data on the 13 most important organisms responsible for nosocomial infections. The percentage of S. maltophilia among these organisms and the number of S. maltophilia per 1000 patient-days were calculated. The data were subsequently correlated with antibiotic use density calculated in defined daily doses (DDDs) per 1000 patient-days and structure parameters. The data covered a total of 28 266 isolates and 431 351 DDDs. The antibiotic use density ranged from 427 to 2218, with the median being 1346. Over the two-year period, the median of S. maltophilia per 1000 patient-days was 1.4 (range 0-7.6). Calculation of antibiotic use and S. maltophilia per 1000 patient-days showed a significant positive correlation with the use of carbapenems, ceftazidime, glycopeptides and fluoroquinolones, as well as with total antibiotic use. In the multiple logistic regression analysis, carbapenem use and >12 ICU beds were independently and positively associated with a high number of S. maltophilia per 1000 patient-days. Benchmarking data provided for incidence densities of S. maltophilia in ICUs revealed the heterogeneous situation of the burden of S. maltophilia in individual ICUs. The multi-centre data showed that carbapenem use and >12 ICU beds were independent risk factors for the isolation of S. maltophilia.

Anti-Bacterial Agents↗

PubMed2005

Monte Carlo treatment planning for molecular targeted radiotherapy within the MINERVA system.

The aim of this project is to extend accurate and patient-specific treatment planning to new treatment modalities, such as molecular targeted radiation therapy, incorporating previously crafted and proven Monte Carlo and deterministic computation methods. A flexible software environment is being created that allows planning radiation treatment for these new modalities and combining different forms of radiation treatment with consideration of biological effects. The system uses common input interfaces, medical image sets for definition of patient geometry and dose reporting protocols. Previously, the Idaho National Engineering and Environmental Laboratory (INEEL), Montana State University (MSU) and Lawrence Livermore National Laboratory (LLNL) had accrued experience in the development and application of Monte Carlo based, three-dimensional, computational dosimetry and treatment planning tools for radiotherapy in several specialized areas. In particular, INEEL and MSU have developed computational dosimetry systems for neutron radiotherapy and neutron capture therapy, while LLNL has developed the PEREGRINE computational system for external beam photon-electron therapy. Building on that experience, the INEEL and MSU are developing the MINERVA (modality inclusive environment for radiotherapeutic variable analysis) software system as a general framework for computational dosimetry and treatment planning for a variety of emerging forms of radiotherapy. In collaboration with this development, LLNL has extended its PEREGRINE code to accommodate internal sources for molecular targeted radiotherapy (MTR), and has interfaced it with the plugin architecture of MINERVA. Results from the extended PEREGRINE code have been compared to published data from other codes, and found to be in general agreement (EGS4-2%, MCNP-10%) (Descalle et al 2003 Cancer Biother. Radiopharm. 18 71-9). The code is currently being benchmarked against experimental data. The interpatient variability of the drug pharmacokinetics in MTR can only be properly accounted for by image-based, patient-specific treatment planning, as has been common in external beam radiation therapy for many years. MINERVA offers 3D Monte Carlo-based MTR treatment planning as its first integrated operational capability. The new MINERVA system will ultimately incorporate capabilities for a comprehensive list of radiation therapies. In progress are modules for external beam photon-electron therapy and boron neutron capture therapy (BNCT). Brachytherapy and proton therapy are planned. Through the open application programming interface (API), other groups can add their own modules and share them with the community.

Boron Neutron Capture Therapy↗

PubMed1997

Carcinoma of the nasopharynx treated by radiotherapy alone: determinants of local and regional control.

PURPOSE: This retrospective study was conducted to review the results of treatment and to identify prognostic factors for local and regional control in a population of 378 patients with nasopharyngeal carcinomas treated in a single institution by radiation therapy alone. METHODS AND MATERIAL: All patients were treated at The University of Texas M. D. Anderson Cancer Center between 1954 and 1992 following a consistent treatment philosophy but with evolving technique. There were 286 males and 92 females with a median age of 52 years (range: 16-86 years). The majority of the patients were Caucasian (282 patients, 75%). Thirty-two patients (8%) had one or more cranial nerve deficits. Three-fourths of the patients presented with AJCC Stage IV disease (T4, N0-3, 118 patients; T1-3, N2-3 164 patients). Histologically, 193 tumors (51%) were squamous cell carcinomas, 154 (41%) lymphoepitheliomas, and 31 (8%) unclassified carcinomas. Average total dose varied with T-stage and ranged from 60.2 to 72.0 Gy. Median follow-up time was 10 years. RESULTS: For the entire population the 5-, 10-, and 20-year actuarial survival rates were 48, 34, and 18%, respectively, with 184 patients (49%) dying of nasopharyngeal cancer. Actuarial control rates at 5, 10, and 20 years were 71, 66, and 66% for the primary site and 84, 83, and 83% for the neck. A total of 100 patients (26%) had local failures and 51 patients (13%) had regional failures with a median time to recurrence of 8.2 months and 13 months, respectively. Advanced T-stage, squamous histology, and presence of cranial nerve deficits were poor prognostic factors for local control in both univariate and multivariate analyses. N-stage and tumor histology were significant factors for neck control. Treatment year, total dose within the ranges used, and duration of treatment did not have any significant effect on local or regional control. The actuarial incidence of Grade 3-5 late complications was 16, 19, and 29% at 5, 10, and 20 years, respectively. Twelve patients (3%) died of treatment-related complications; all but one fatal complication occurred before 1971 and the other in 1976. CONCLUSIONS: This study shows very good long-term local and regional control rates for nasopharyngeal carcinomas after definitive radiotherapy and establishes a benchmark for newer treatment strategies. Improvements in treatment technique over the years have dramatically reduced the frequency of severe late complications. Patients with advanced stage tumors and differentiated squamous histology have a relatively poor prognosis when treated with conventional radiotherapy and are candidates for dose escalation or combined modality studies.

Adolescent↗

PubMed2002

Dobutamine stress echocardiography for the detection of myocardial viability in patients with left ventricular dysfunction taking beta blockers: accuracy and optimal dose.

OBJECTIVE: To assess the accuracy of dobutamine stress echocardiography (DSE) and the optimal dose of dobutamine to detect myocardial viability in patients with ischaemic left ventricular (LV) dysfunction who are taking beta blockers, using the recovery of function six months artery revascularisation as the benchmark. PATIENTS: 17 patients with ischaemic LV dysfunction (ejection fraction < 40%) and chronic treatment with beta blockers scheduled to undergo surgical revascularisation. SETTING: Regional cardiothoracic centre. METHODS: All patients underwent DSE one week before and resting echocardiography six months after revascularisation. A wall motion score was assigned to each segment for each dobutamine infusion stage, using the standard 16 segment model of the left ventricle. The accuracy of DSE to predict recovery of resting segmental function was calculated for low dose (5 and 10 microg/kg/min) and for a full protocol of dobutamine infusion (5 to 40 microg/kg/min). RESULTS: Of the 272 segments studied, 158 (58%) were dysfunctional at rest, of which 79 (50%) improved at DSE and 74 (47%) recovered resting function after revascularisation. Analysis of results with a low dose showed a significantly lower sensitivity and negative predictive value than with a full protocol (47% v 81%, p < 0.001 and 65% v 82%, p < 0.05, respectively). The accuracy in the full protocol analysis was comparable with that reported in patients no longer taking beta blockers but was significantly lower than that in the low dose analysis (78% v 66%, p < 0.001). CONCLUSIONS: Findings suggest that beta blocker withdrawal is not necessary before DSE when viability is the clinical information in question. However, a completed protocol with continuous image recording is required to detect the full extent of viability.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Dose of case management interventions.

Case management programs need to be evaluated for outcomes achievement and efficient use of resources. As a provider intervention, case management is interactional and situational. Little is known about how to measure the actual dose delivered in order to assess quality and manage outcomes. Case management is interdisciplinary, has identifiable dimensions, and serves as a practical example of conceptualizing and measuring the dosage of a provider's intervention. The basic elements of the dosage of an intervention are amount, frequency, duration, and breadth. A three-dimensional model illustrates dosage of case management.

Benchmarking↗

PubMed2000

Single dose oral aspirin for acute pain.

BACKGROUND: Aspirin has been known to be an effective analgesic for many years and is commonly used throughout the world for many different pain conditions. It is important for both prescribers and patients to have the best possible information about the efficacy and safety of analgesics, and this need is reflected in patient surveys which show that postoperative pain is often poorly managed. We also need to benchmark relative efficacy and safety of current analgesics so that we can compare them with new analgesics. OBJECTIVES: To quantitatively assess the analgesic efficacy and adverse effects of a single-dose of aspirin in acute pain of moderate to severe intensity. SEARCH STRATEGY: Randomised trials were identified by searching Medline (1966 to March 1998), Embase (1980 to January 1998), the Cochrane Library (Issue 1,1998) and the Oxford Pain Relief Database (1950 to 1994). SELECTION CRITERIA: The inclusion criteria used were: full journal publication, postoperative pain or a mixture of postoperative and acute trauma pain, oral administration, adult patients, baseline pain of moderate to severe intensity, double-blind design, and random allocation to treatment groups which compared aspirin with placebo. DATA COLLECTION AND ANALYSIS: Summed pain relief or pain intensity difference over four to six hours was extracted, and converted into dichotomous information yielding the number of patients with at least 50% pain relief. This was then used to calculate the relative benefit and the number-needed-to-treat (NNT) for one patient to achieve at least 50% pain relief. MAIN RESULTS: Seventy-two randomised single-dose trials met our inclusion criteria, with 3253 patients given aspirin, and 3297 placebo. Significant benefit of aspirin over placebo was shown for aspirin 600/650 mg, 1000 mg and 1200 mg, NNTs for at least 50% pain relief of 4.4 (4.0 to 4.9), 4.0 (3.2 to 5.4) and 2.4 (1.9 to 3.2) respectively. Single-dose aspirin 600/650 mg produced significantly more drowsiness and gastric irritation than placebo, with a number-needed-to-harm (NNH) of 28 (19 to 52) and 38 (22 to 174) respectively. Type of pain model, pain measurement, sample size, quality of study design, and study duration had no significant impact on the results. REVIEWER'S CONCLUSIONS: Aspirin is an effective analgesic for acute pain of moderate to severe intensity with a clear dose-response. Drowsiness and gastric irritation were seen as significant adverse effects even though the studies were single-dose. The pain relief achieved with aspirin was very similar milligram for milligram to that seen with paracetamol.

Acute Disease↗

PubMed2000

Complications from radiotherapy dose escalation in prostate cancer: preliminary results of a randomized trial.

OBJECTIVE: To compare early and late side effects in prostate cancer patients with Stage T1b-T3 disease randomized to receive 70 Gy or 78 Gy. METHODS: There were 189 patients randomized with a minimum follow-up of 2 years, that were available for this analysis. All patients were initially treated with a 4-field box to an isocenter dose of 46 Gy at 2 Gy per fraction. In the 70-Gy arm, treatment was continued to a reduced volume using a 4-field box technique. In the 78-Gy arm, treatment was continued to a reduced volume using a conformal 6-field arrangement. Side effects were graded on a 1-4 scale, adapted from Radiation Therapy Oncology Group and Late Effects Normal Tissue Task Force criteria. RESULTS: No significant differences in acute rectal or bladder toxicity were seen between the two treatment techniques (p > 0.6 for all comparisons). The 5-year Kaplan-Meier risks of Grade 2 or higher late bladder toxicity were 20% and 9% for 70-Gy and 78-Gy groups, respectively (log rank, p = 0.8). The 5-year risks of Grade 2 or higher late rectal toxicity were 14% and 21% for 70 Gy and 78 Gy, respectively (p = 0.4). Dose-volume histogram analysis of the 78-Gy patients showed a significant correlation between the percentage of rectum irradiated to 70 Gy or greater and the likelihood of developing late rectal complications. Patients with more than 25% of the rectum receiving 70 Gy or greater had a 5-year risk of Grade 2 or higher complications of 37% compared to 13% for patients with 25% or less (p = 0.05). All three Grade 3 complications occurred when greater than 30% of the rectum received 70 Gy or more. CONCLUSION: The overall rate of complications was similar in both treatment arms. However, there is evidence for a significant increase in late rectal complications when more than 25% of the rectum received 70 Gy or greater. This parameter may serve as a benchmark for the design of future three-dimensional conformal trials.

Aged↗

PubMedDate not supplied

Retention and viability characteristics of mammalian cells in an acoustically driven polymer mesh.

A processing approach for the collection and retention of mammalian cells within a high porosity polyester mesh having millimeter-sized pores has been studied. Cell retention occurs via energizing the mesh with a low intensity, resonant acoustic field. The resulting acoustic field induces the interaction of cells with elements of the mesh or with each other and effectively prevents the entrainment of cells in the effluent stream. Experiments involving aqueous suspensions of polystyrene particles were used to provide benchmark data on the performance of the acoustic retention cell. Experiments using mouse hybridoma cells showed that retention densities of over 1.5 x 10(8) cell/mL could be obtained. In addition, the acoustic field was shown to produce a negligible effect on cell viability for short-term exposure.

Acoustics↗

PubMed2005

Comparison of synchrotron radiation calculations between analytical codes (STAC8, photon) and Monte Carlo codes (FLUKA, EGS4).

STAC8 is a significant improvement upon its predecessor PHOTON and is a valuable analytical code for quick and conservative beamline shielding designs for synchrotron radiation (SR) facilities. In order to check the applicability, accuracy and limitations of STAC8, studies were conducted to compare the results of STAC8 with those of PHOTON with calculations using the FLUKA and EGS4 Monte Carlo codes. Doses and spectra for scattered SR in a few beam-target-shield geometries were calculated, with and without photon linear polarisation effects. Areas for expanding the STAC8 capabilities, for example, features of the mirror-reflected lights and double-Compton light calculations and the use of monochromatic light have been identified. Some of these features have been implemented and benchmarked against Monte Carlo calculations. Reasonable agreements were found between the STAC8 and Monte Carlo calculations.

Algorithms↗

PubMed2000

Behavioral and pharmacological treatment methods for pregnant smokers: issues for clinical practice.

Active and passive exposure to tobacco smoke are the most serious and preventable causes of poor maternal, fetal, and infant outcomes in the United States. Unfortunately, the majority of pregnant smokers do not quit smoking before or during pregnancy or after childbirth. We describe a standardized behavioral counseling model and discuss issues to consider in recommending the use of pharmacotherapy during pregnancy. Although the Food and Drug Administration no longer classifies nicotine replacement therapy (NRT) as contraindicated during pregnancy, precautions should be carefully considered for use in this population. This paper provides a synopsis of the risks of exposure to tobacco smoke during pregnancy and the postpartum; estimates the population at risk and the potential for increased cessation if effective health education methods during pregnancy were routinely provided; presents a meta-analysis of "best practice" patient education methods for pregnant smokers; and estimates the number of pregnant heavy smokers who might be eligible for NRT. We suggest five issues for the physician to consider before recommending NRT medications to pregnant patients who are heavy smokers. The judicious use of NRT medications may significantly reduce harm to the infants of heavy smokers. More evidence derived from large population-based research, however, is needed to provide guidance to the physician about NRT eligibility, dose, scheduling, and effectiveness in clinical practice.

Adult↗

PubMed2005

High precision EPR dosimetry as a reference tool for validation of other techniques.

We present here a particular application area for EPR dosimetry with teeth--use as a source of reference dose values for validation/verification of other retrospective dosimetry techniques and existing dose records. The conditions of application of EPR dosimetry in this role as well as practical design of such studies are shown. Particular attention is given to the requirements to the techniques in terms of precision and throughput, as well as to the issue of availability of samples for analysis and practical solution of this problem. Practical application of this approach is illustrated by several examples of completed validation sub-studies, which were performed in the framework of large-scale post-Chernobyl epidemiological studies.

Benchmarking↗

PubMed2002

Short-term inhalation toxicity of polyisocyanate aerosols in rats: comparative assessment of irritant-threshold concentrations by bronchoalveolar lavage.

The object of this study was to compare the relative potency of respirable aerosols of the aliphatic hexamethylene 1,6-diisocyanate homopolymer of the isocyanurate type (HDI-IC) and the aromatic polymeric methylenediphenyl-4,4'-diisocyanate (pMDI) to elicit early changes in bronchoalveolar lavage fluid (BALF). The validity of the concentration x time (C x t) concept was addressed in rats exposed to concentrations from 3.4 to 58.1 mg pMDI/m3 and exposure durations of 6 h to 23 min, respectively (C x t approximately 1200 mg/m3-min). One additional group of rats was exposed to 2.7 mg MDA/m3 for 1 x 6 h, a putative product of hydrolysis of pMDI. In rats repeatedly exposed to 12.9 mg pMDI/m3 (6 h/day, 5 days/wk for 14 days), cumulative exposure-related changes were examined. Results show that total protein and angiotensin-converting enzyme (ACE) in BALF were among the most sensitive endpoints to probe early effects caused by exposure to irritant polyisocyanate aerosols. In the repeated-exposure study, BALF protein was maximal after the first exposure day. Based on these most sensitive endpoints in BALF, a benchmark no-effect threshold concentration of 0.5 and 3 mg/m3 was estimated for the pMDI and HDI-IC aerosol, respectively. The slope of the concentration-effect curve was steeper following exposure to HDI-IC than to pMDI. These estimated acute no-observed-effect levels (NOELs) were almost identical to those observed in longer term inhalation studies using conventional endpoints. It is concluded that pulmonary irritation caused by polyisocyanate aerosols can readily be quantified in an acute rat bioassay by the analysis of total protein in BALF.

Aerosols↗

PubMed2005

Economic analysis of the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT-3) study: costs of reperfusion strategies in acute myocardial infarction.

BACKGROUND: The ASSENT-3 study examined the safety and efficacy of 3 alternative regimens for ST-elevation acute myocardial infarction: full-dose tenecteplase (TNK-tPA) plus enoxaparin; half-dose TNK-tPA plus unfractionated heparin plus abciximab; and full-dose TNK-tPA plus unfractionated heparin. OBJECTIVE: The aim of the study was to examine the resource and economic effects of the 3 regimens in ASSENT-3 using empirically collected data from the trial. METHODS: Cost estimates for each resource use component collected in ASSENT-3 were derived from Medicare reimbursement rates and from detailed billing data collected as part of a previous study. Costs of study drugs were estimated using average wholesale prices. All analyses were by intention to treat. Resource use and medical costs were examined first in the United States alone, and then in the entire cohort. RESULTS: Differences in costs across treatment arms were primarily due to differences in cost of study medication. Irrespective of source of cost weights, the least expensive alternative among the 3 treatment regimens was TNK-tPA and enoxaparin. Although not statistically significant, in 80% of 1000 bootstrap replications, the TNK-tPA enoxaparin arm was associated with 30-day cost savings relative to the unfractionated heparin arm. CONCLUSION: The favorable clinical outcomes demonstrated for enoxaparin arm relative to the unfractionated heparin arm in ASSENT-3 were accompanied by a favorable distribution of costs and support the designation of this regimen as economically attractive by conventional benchmarks.

Abciximab↗

PubMed2002

Haloperidol dose for the acute phase of schizophrenia.

BACKGROUND: Haloperidol is a benchmark, accessible antipsychotic against which the effects of newer treatments are gauged. OBJECTIVES: The primary goal of this review is to determine the best range of doses for haloperidol for the treatment of people acutely ill with schizophrenia. SEARCH STRATEGY: The reviewers searched Biological Abstracts (1980-1999), CINAHL (1982-1999), The Cochrane Library (1999, Issue 2), The Cochrane Schizophrenia Group's Register (December 1999), EMBASE (1980-1999), MEDLINE (1966-1999) and PsycLIT (1887-1999). They also inspected all references of all identified trials and included studies sought as a citation on SCISEARCH database (1980-1999). Authors of identified studies and pharmaceutical companies were also contacted. SELECTION CRITERIA: Studies were selected if they involved people being treated for acute schizophrenia, randomised to two or more dose ranges of non-depot haloperidol, and if they reported clinically meaningful outcomes. DATA COLLECTION AND ANALYSIS: The reviewers independently and blindly inspected citations (10% reliability check), they ordered papers, and reliably re-inspected and quality assessed the full reports. The reviewers, again working independently, also extracted data. For homogeneous dichotomous data the relative risk (RR), 95% confidence intervals (CI) were calculated on an intention-to-treat basis. Reviewers assumed that people who left the study early or were lost to follow-up had a negative outcome. Weighted mean differences (WMD) were calculated for continuous outcomes that reported intention to treat (ITT), last observation carried forward (LOCF) data. Data was excluded if loss to follow-up was greater than 50%. MAIN RESULTS: Sixteen trials with nineteen different randomised dose comparisons were included. No studies reported data on relapse rates, quality of life and none compared >1.5-3.0 mg/day haloperidol to higher dose ranges. Using low doses (>3-7.5mg/day) did not clearly result in loss of efficacy (no clinically important improvement in global state, versus >7.5-15mg/day n=48, 1 RCT, RR 1.09 CI 0.7 to 1.8; versus >15-35mg/day n=81, 2 RCTs, 0.95 CI 0.8 to 1.2). Doses of haloperidol in the range of >3-7.5 mg/day had a lower rate of development of clinically significant extrapyramidal adverse effects than higher doses (clinically significant extrapyramidal adverse effects, versus >7.5-15mg/day n=64, 2 RCTs, RR 0.12 CI 0.01 to 2.1; versus >15-35mg/day n=144, 3 RCTs RR 0.59 CI 0.5 to 0.8, NNH 3 CI 2 to 6; versus >35mg/day n=86, 2 RCTs, RR 0.70 CI 0.5 to 1.1). All other comparisons between dose ranges did not yield statistically significant differences, but several, particularly with lower dose ranges, were underpowered to detect clinically meaningful differences. REVIEWER'S CONCLUSIONS: No results are conclusive and all are based on small, short, studies. It would be understandable, however, if clinicians were cautious in prescribing doses in excess of 7.5 mg/day of haloperidol to a person with uncomplicated acute schizophrenia, and if people with schizophrenia were equally reticent to take greater doses. Further research is needed regarding the efficacy and tolerability of the >1.5-3.0 mg/day dose range.

Acute Disease↗

PubMed2006

Persistent neurobehavioral effects of early postnatal domoic acid exposure in rats.

Domoic acid (DA) is a marine biotoxin, produced by the diatom Pseudo-nitzchia spp., which has been shown to cause cognitive impairment in adults who are exposed via contaminated seafood. The neurobehavioral consequences of developmental exposure are much less well understood. In a previous study, we showed that a single prenatal exposure to DA in rats at mid-gestation caused neurobehavioral changes that persist into adulthood including increased susceptibility to the benchmark amnestic drug scopolamine. In the current study, we examined the lasting neurobehavioral consequences of DA exposure on the first day of postnatal life, a time in rats marking the completion of the major phase of neuroproliferation and corresponding to week 24 of human gestation. The effects of DA exposure at doses from 0.025-0.1 mg/kg (s.c.) twice per day on each of postnatal days 1 and 2 were compared with vehicle-treated controls and rats treated by the same protocol with 1 mg/kg of kainic acid. Following kainic acid exposure, a sex-selective effect was seen with females but not males showing a significant slowing of response latency in the radial-arm maze. The high DA dose of 0.1 mg/kg was quite toxic causing lethality in all of the offspring exposed and this group was excluded from further analysis. When the offspring in the 0.05 mg/kg DA dose group were tested, significant hypoactivity in the Figure-8 maze was observed during adolescence. No significant DA effects were seen in response latency or choice accuracy on the radial-arm maze during either acquisition or with challenge of the amnestic drug scopolamine. Early postnatal DA exposure in the rat can be lethal and sublethal exposure can cause neurobehavioral effects manifest in modest hypoactivity during the adolescent period. However, the sublethal persistent neurobehavioral toxicity appears to be less pervasive than reported effects following DA administered mid-gestation.

Animals↗

PubMed2006

Process economics of industrial monoclonal antibody manufacture.

Pressures for cost-effective manufacture of antibodies are growing given their high doses and increasing market potential that have resulted in significant increases in total site capacities of up to 200,000 L. This paper focuses on the process economic issues associated with manufacturing antibodies and reviews the cost studies published in the literature; many of the issues highlighted are not only specific to antibodies but also apply to recombinant proteins. Data collated at UCL suggest current benchmark investment costs of $660-$1580/ft2 ($7130-$17,000/m2) and $1765-$4220/L for antibody manufacturing facilities with total site capacities in the range of 20,000-200,000 L; the limitations of the data are highlighted. The complications with deriving benchmark cost of goods per gram (COG/g) values are discussed, stressing the importance of stating the annual production rate and either titre or fermentation capacity with the cost so as to allow comparisons. The uses and limitations of the methods for cost analysis and the available software tools for process economics are presented. Specific examples found in the literature of process economic studies related to antibody manufacture for different expression systems are reviewed. The key economic drivers are identified; factors such as fermentation titre and overall yield are critical determinants of economic success. Future trends in antibody manufacture that are driven by economic pressures are discussed, such as the use of alternative expression systems (e.g. transgenics, E. coli and yeast), disposables, and improvements to downstream technology. The hidden costs and the challenges in each case are highlighted.

Animals↗

PubMed1999

CT-based dosimetry calculations for 125I prostate implants.

PURPOSE: To evaluate the Monte Carlo code MCNP4B for low-energy brachytherapy calculations, including the effects of interseed attenuation and patient specific heterogeneities, on the calculated dose distribution from transperineal implantation of 125I. METHODS AND MATERIALS: The Monte Carlo code MCNP4B was used to model and benchmark the absolute dose distribution from two 125I brachytherapy seeds (model 6711 and 6702). Based upon the physical source model, the total photon intensity and differential energy spectrum were evaluated as a function of angle from the transverse bisector of the source. These spectral and intensity data were reformatted to produce probability distributions for sampling from a virtual point source. The virtual source model and a modified version of MCNP4B is then used for simulating arbitrary brachytherapy source configurations within a homogeneous or heterogeneous patient specific computed tomography (CT)-based lattice geometry. RESULTS AND CONCLUSION: Comparison with TG-43 data and the Monte Carlo calculations is excellent with MCNP4B predicting the radial dose function for the 125I 6711 and 6702 sources within 6% for all data points tested. Attenuation effects from neighboring seeds were investigated for pre- and postimplant seed distributions and found to be negligible. Preliminary dosimetry analysis of postimplant seed distributions comparing homogeneous water versus heterogeneous CT simulation geometries indicates an average decrease of approximately 5.6% for the volume of tissue irradiated to a prescription isodose line of 144 Gy.

Brachytherapy↗